Healthcare Provider Details

I. General information

NPI: 1457920076
Provider Name (Legal Business Name): SHANAE VIZZA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 DOUBLE DIAMOND PKWY STE 200
RENO NV
89521-5842
US

IV. Provider business mailing address

5310 KIETZKE LN STE 104
RENO NV
89511-2043
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-8800
  • Fax: 833-687-1419
Mailing address:
  • Phone: 775-348-8800
  • Fax: 833-687-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2563
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2563
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: